Last week, the Senate overwhelmingly passed a joint Defense and Labor-HHS appropriations bill that would increase federal health spending in the upcoming fiscal year. Notably, the bill would increase funding for some mental health and addiction programs as well as provide around $3.7 billion to specifically to address the opioid addiction crisis. House and Senate members now face a time crunch to reconcile their appropriations bills before a September 30th funding deadline and potential government shutdown.

Last week, the National Council submitted comments to the Centers for Medicare and Medicaid Services (CMS) regarding Kentucky’s Medicaid proposal to impose work requirements on Medicaid beneficiaries. In July, a district court judge blocked the state’s waiver request and required the agency to reevaluate the waiver application and analyze its impact on beneficiaries. This legal decision only applies to Kentucky and has no bearings on work requirements being imposed in other states.

New guidance from the Centers for Medicare and Medicaid Services (CMS) reports updated policies and procedures around state plan amendments (SPAs), 1115 waivers and 1915 waivers in states’ Medicaid programs. Two informational bulletins released within the past week outline the agency’s efforts to streamline approval processes and provide clarity around these options that are meant to give states flexibility in how they administer their Medicaid programs. These updates are part of CMS’s ongoing efforts to address concerns from states and federal policymakers around long administrative approval times and lack of transparency and oversight.

Many states across the country are pushing back against the Trump Administration’s recent expansion of short-term health plans, which would make bare-bones plans that are exempt from critical coverage provisions of the Affordable Care Act more widely available in the individual market. Officials in California, Illinois, Vermont, and Hawaii are seeking varied solutions to limit the effects of the change. The National Council strongly opposes the recent federal ruling to expand short-term health plans.

CMS is planning significant changes to a value-based payment model known as Accountable Care Organizations (ACOs) in a sweeping rule proposed last week. The rule would give new ACOs just two years before they must start sharing savings and losses with the agency. The proposal has drawn criticism from hospital groups and ACO stakeholders, who say the plan will cause many ACOs to leave the program. Comments on the proposed rule are due by October 16, 2018.

As states move more Medicaid services to managed care, the National Council for Behavioral Health has released Medicaid Managed Care Contracting, an advocacy guide to ensure mental health and addiction care is protected under managed care arrangements. Behavioral health providers are often subject to practices that restrict reimbursement and reduce patients’ options. The guide offers community behavioral health providers and associations talking points and sample contract language they can use with their state Medicaid agency to ensure Medicaid managed care will enhance behavioral health access.

Beginning in October, bare-bones, short-term health plans that are exempt from critical coverage provisions of the Affordable Care Act (ACA), will become more widespread in the insurance market. A final rule issued this week by the Departments of Health and Human Services (HHS), Labor and Treasury would permit the sale of limited health coverage plans that expose consumers to more risks and potentially larger medical bills when seeking critical care. The National Council strongly opposes any moves that undermine the availability of comprehensive coverage, including mental health and addiction benefits offered at parity.

A new bill would establish a loan repayment program for mental health care providers that commit to working in designated high-needs communities. Representatives John Katko (R-NY) and Grace Napolitano (D-CA) introduced the bipartisan legislation, called the Mental Health Professionals Workforce Shortage Loan Repayment Act of 2018 (H.R.6597), to address a critical shortage in the number of mental health care providers across the country.

The Trump Administration intends to continue approving states’ requests to institute work requirements on Medicaid enrollees, despite a recent court ruling that set such efforts back. In an address last week, Health and Human Services (HHS) Secretary Alex Azar said the administration is ‘undeterred’ after a federal judge blocked Kentucky’s Medicaid work requirements last month. This move invalidated the Centers for Medicare and Medicaid Services’ (CMS) approval of an 1115 Medicaid waiver to redefine eligibility for the public program in Kentucky.